Preliminary Pressure Ulcer Risk Assessment (PPURA)

It does this by focusing on a collection of factors that are known to impact on an individual’s risk of developing a pressure ulcer. You as a care provider are of course encouraged to use your clinical judgment and your knowledge of individual patients/clients to support this assessment.

How was this tool developed?

This tool was developed by an expert group in Scotland as part of the National Tissue Viability programme. As with all the work on this website, we have also drawn on expertise outside Scotland.

First, we identified a collection of risk factors through a 2-round method of consensus with Scotland’s Tissue Viability Nurse Experts. We then mapped these factors to those identified by an extensive systematic literature search undertaken by Professor Jane Nixon and colleagues at the University of Leeds. This work helped us isolate a collection of factors which are important in identifying risk of developing a pressure ulcer. These factors were further considered by an expert group who agreed on the same list of important factors. Professor Nixon has been very supportive of our work and has been constructive in her comments on the tool during the consultation stage. Professor Andrea Nelson (University of Leeds) contributed to our working group and was helpful in her advice and support as the tool was developed and tested using improvement methodology. In addition, we drew on the expertise of Dr Michael Clark, professional advisor to the Tissue Viability Society and Trustee of the European Pressure Ulcer Advisory Panel (EUPAP). 

Following initial work in identifying these factors there was much discussion in the expert group on how the elements of the tool should be presented. Changes were made to the tool’s design in response to comments made during the consultation and testing process.  The resulting tool is designed to be easily photocopied, and clipped into the patient/client notes. It is designed to be easily completed every day or when there is a change in circumstances or condition.

We have also drawn on work in Wales where we identified an area of best practice in pressure ulcer prevention. Mr Hamish Laing and the team at ABM University Health Board, South Wales have carried out extensive work in pressure ulcer prevention using a care bundle approach. The bundle comprises a set of evidence-based actions which, if undertaken together, minimise the occurrence of a pressure ulcer. The care giver starts to use the care bundle if an individual is judged to be at risk or has a pressure ulcer.  

As part of our innovation stream of work (Autumn 2010) we are currently conducting small tests of change with this risk assessment to see if it can lead straight to the care bundle without further assessment.

Some questions and answers:

Why another risk assessment tool?

This tool is to be used as an initial risk assessment tool. It is designed to swiftly identify those clearly at risk of developing a pressure ulcer and screen out those not at risk.

This tool is best considered as ‘upstream’ from the Braden and Waterlow assessments - these are extensive multifactorial assessments which you could use once someone has been identified as ‘at risk’ and if you need more detail on their circumstances. In general, however, you can move straight to implementing the care bundle if the risk assessment shows the patient/client to be at risk.

What if the preliminary pressure ulcer risk assessment tool suggests a person is at risk of developing a pressure ulcer?

A full pressure ulcer risk assessment should be undertaken and consideration should also be given to other assessments.  

What can I do for my patient/client to minimise a pressure ulcer occurring?

Use the care bundle to act swiftly to minimise risk and give the right care at the right time.